title: Integration of human papillomavirus vaccination and cervical cancer screening in Latin America and the Caribbean.
abstract: Despite substantial efforts to control cervical cancer by screening, most Latin American and Caribbean countries continue to experience incidence rates of this disease that are much higher than those of other Western countries. The implementation of universal human papillomavirus (HPV) vaccination for young adolescent women is the best prospect for changing this situation. Even though there are financial challenges to overcome to implement such a policy, there is broad political support in the region for adopting universal HPV vaccination. The costs of implementing this policy could be largely alleviated by changing cervical cancer control practices that rely on inefficient use of resources presently allocated to cytology screening. In view of the strong evidence base concerning cervical cancer prevention technologies in the region and the expected impact of vaccination on the performance of cytology, we propose a reformulation of cervical cancer screening policies to be based on HPV testing using validated methods followed by cytologic triage. This approach would serve as the central component of a system that plays the dual role of providing screening and surveillance as integrated and complementary activities sharing centralized resources and coordination.
authors.affiliation: Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada. eduardo.franco@mcgill.ca
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.forename: Vivien
authors.initials: V
authors.lastname: Tsu
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lazcano-Ponce
authors.forename: Allan
authors.initials: A
authors.lastname: Hildesheim
authors.forename: Nubia
authors.initials: N
authors.lastname: Muñoz
authors.forename: Raul
authors.initials: R
authors.lastname: Murillo
authors.forename: Gloria Ines
authors.initials: GI
authors.lastname: Sánchez
authors.forename: Jon Kim
authors.initials: JK
authors.lastname: Andrus
mesh_terms: D017691:Caribbean Region / Q000453:epidemiology; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007843:Latin America / Q000453:epidemiology; D008403:Mass Screening / Q000458:organization & administration*; D030361:Papillomavirus Infections / Q000276:immunology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines